EKG recording accessory system (EKG RAS)

ABSTRACT

The invention is a precordial pad for positioning EKG electrodes on a patient for anatomically correct and repeatable placement. Data can be transmitted from the EKG pad of the invention by wire or wireless means. The pad includes a sizing aid, and a positioning device. The invention is also a system for obtaining and sending EKG data.

PRIORITY

This application claims the priority date of the provisional applicationentitled EKG Recording Accessory System (EKG RAS) filed by AlirezaNazeri on Mar. 4, 2003, with serial No. 60/452,483, the disclosure ofwhich is incorporated herein.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention generally relates to an EKG contact electrode pad,and more particularly relates to EKG contact pads with temperaturesensors, sizing selection, and placing means.

2. Background Information

Electrocardiography (EKG, ECG) is a medical test for recording theelectrical activity of the heart. In the standard twelve lead EKG thereare twelve (12) different wires that carry electrical signals from thearea of the body to which they are attached. Certain leads are attachedto the person's chest in six standard areas. These are known asprecordial leads. Four of the twelve leads are the four limb electrodes:right wrist, left wrist, right ankle and left ankle. In some cases, theplacing of two extra lead electrodes in the right side of the patient'schest allows the possibility to record the EKG of the right heart. Thelimb leads are designated RL, RF, LL, and LF, and attach respectively tothe two ankles and the two wrists of the patient. The precordial leadsare designated as V1, V2, V3, V4, V5, and V6, and the leads for theright side of the heart are designated VR1 and VR2. The limb leads canbe placed in an “adjusted” position, rather than on the extremities. Theadjusted position for the limb leads are on the torso of the patient.

From the time of the invention of EKG to present usage, each electrodeis generally connected separately to the EKG recorder by wire. Thismeans that, for the routine twelve lead EKG, we need at least ten (10)separate electrodes attached to standard anatomical positions and ten(10) wires that go separately to the EKG machine. In the configurationsincluding the right heart EKG, they will become twelve (12) separateelectrodes. These standard electrode placements can also be used forelectrodes for an external pacemaker, a defibrillation device, and forreal time heart monitoring of the patients in critical care units.

The results of the EKG will be printed as a graph on standard paper orshown on the monitor. EKG is the most commonly used diagnostic test inmedicine for evaluating the function of the heart. Reading the EKG isvery important in patient management, as the difference between a normaland an abnormal reading can be measured in millimeters on the chart.Correct placement of electrodes in the standard positions, attachment tothe skin, perfect conductivity, and the least artifacts as possible inthe recording are the keys in the repeatability, accuracy, andreliability of this procedure. For the best performance, a skilledphysician or technician should place the electrodes. With the currentlyavailable methods of electrode placement, there can be significanterrors produced in the EKG recordings. For example, one person may placethe electrodes in a different position than another person, and the sameperson can place them in another position at a different time. Even ifplaced predictability, it could be placed in a wrong anatomicalposition.

Thus, in the conventional placement of the electrodes, therepeatability, accuracy, and reliability of the data are suspect,especially in emergency situations when procedures are carried outrapidly and in difficult situations.

Therefore, what is needed are repeatability, consistency, and accuracyin the placement of electrodes for an EKG recording on the same patientwith different users, or on different patients by the same user.

Additional objects, advantages, and novel features of the invention willbe set forth in part in the description which follows, and in part willbecome apparent to those skilled in the art upon examination of thefollowing or may be learned by practice of the invention. The objectsand advantages of the invention may be realized and attained by means ofthe instrumentalities and combinations particularly pointed out in theappended claims

SUMMARY OF THE INVENTION

These objects, as well as others, are accomplished by the EKG pad of theinvention. The repeatability is provided by an array of electrodes thatare mounted in a disposable precordial pad. The precordial pad of theinvention has an array of EKG electrodes and a temperature sensordistributed on a flexible, multi-layer material. The flexible materialforms a pad body, which has an outer surface and a body surface. Thebody surface of the precordial pad body includes an adhesive layer,which stabilizes the pad on a person's torso and ensures that thereadings are taken during a test from one, and only one, position on thepatient's chest. The adhesive layer of the precordial pad is covereduntil it is ready for use. The precordial pad is covered by an adhesivecover, which is stripped off to expose the adhesive surface when the padis ready to be used. The body surface also includes conductiveelectrodes and a temperature sensor, which will contact the patient'sskin.

The pad also has a middle layer, which is the main circuit layer. Thecircuit layer includes a printed circuit that collects all data from allapplicable electrodes, sensors, and attachments of the pad and bringsthem to the one area on the outer surface of the pad. The circuit layeris designed and made to be capable of tolerating higher voltages thatmay be used for defibrillation. The printed circuit can be made ofcopper, conductive ink, or other electrically conductive material.

The outer surface pad also includes a signal export area. This is wherethe data-transmitting module attaches to the pad and carries all of thesignals from one point to the EKG machine. The signal export module canbe a wireless transmitter that transmits data from the precordial pad tothe EKG machine via the system adaptor. The module is also capable oftransmitting data via a conventional wiring harness, as single cableincludes a bundle of wires leaving the main precordial pad to a designeduniversal adaptor of the invention, which is connected to an EKGmachine.

The invention is also a system for taking the EKG of a patient, whichhas a capability of performing defibrillation, external pacing, andmonitoring the patient's heart at the same time and with the sameprecordial pad. The system includes a disposable EKG precordial pad asdescribed above, as well as some additional components. The additionalcomponents include a measuring device, which is used to measure the sizeof the patient's test area such as his chest or torso. Depending on thesize of the patient's test area, a size of precordial pad is selectedbased on the testing system of the invention. For instance, sizes 1, 2,3, and 4 may be available for various sizes of patients. Sizing can alsoinclude consideration for gender, as pads for males are likely to belarger than those for females. Pad sizes can also be designated asSmall, Medium, Large, Extra Large, etc. Other designations are obviouslypossible and would be related to an indication on the measuring deviceof the invention. The correct size of the pad can also be determinedbased on the patient's gender and shirt size.

The system includes a positioning device, which can be used to measure apatient for pad size, as well as aid the caregiver in positioning a padcorrectly on a patient. The positioning device of the system is usedwith the well-known anatomical marker on the human chest called theSupra Sternal Notch. By placing a curved edge of the positioning deviceon the patient's supra sternal notch, the precordial pad can be placedaccurately and consistently in the anatomically correct position, withthe electrodes thus placed correctly. This feature allowsnon-professional users to place the EKG electrodes on themselves withhigh accuracy. This has not been possible with EKG electrodes in theprior art.

The pad is also composed of materials to be translucent to the X-Ray sopatients can wear the pad while they are being x-rayed. The pad is alsodesigned and composed of materials to be water resistant and waterproof.The pad is also from biocompatible material to make the least allergicreaction for the patients. The pad may also be worn while the patient isgetting an MRI.

The Signal Export Module is another part of this system. This has aninterface for connection to the signal export area of the pad. Thesignal export module receives signals from the related electrodes andsensors. It can include a connection site for connection of a singlecable, which can be used to transmit the data to the universal adaptor.The cable can be regular wire or fiber optic. The module also cancontain a micro-transmitter to transmit data wirelessly to the universaladaptor. This will have the benefit of wireless transmission and canutilize bluetooth, infrared, wi-fi, or other wireless technologies. Oneway to select between wireless and wired transmission is to activate thewireless mode, unless a cable is connected to the module. It wouldtypically have a rechargeable long life lithium battery, or anothersuitable battery type. The signal export module can also have a datarecognition sensor to sense the EKG signals and send an alarm if thepatient has certain preprogrammed changes in his or her EKG, such asarrhythmias. The wireless feature of the pad allows the patient to wearthe pad, put the module on wireless mode, and be able to move around, goto the bathroom, go to the lunchroom, move in a wheelchair, etc. Thepattern recognition ability of the system will automatically send analarm signal if an abnormal event happens.

The Universal Adaptor/Receiver is another part of the invention. Itsfeatures will include compatibility with all of the current or futureEKG recorders in the market. It includes an input site for the wiresfrom the recorder and a site for connection of the wires from the padand limb electrodes. This part will be used for the wire transmission ofdata from the pad to the EKG machine. The adaptor/receiver also containsa receiver for receiving data wirelessly from the micro-transmitter andtransferring them to the recorder. It also includes a digital display toshow body temperature. A switch will allow the adaptor/receiver toselect wire or wireless transmission mode, and to change output to theselected format for the EKG machine in use, or for a defibrillator,external heart pacing system, or for real time monitoring.

The pad is disposable so that it will be used for only one patient. Thiswill limit the risk of transmitting skin disorders from one person toanother, which is a concern in the currently available method.

An important feature of the pad is that the electrodes embedded in thepad extend from the pad surface for better contact. Rather than beingflush with the pad, the electrode layer of the pad includes a devicethat causes the electrodes to extend away from the pad by two to fivemillimeters. The electrode-extending device would also exert a smallamount of pressure so that when the pad is attached to the patient'schest, the extended electrodes press harder against the patient's skinthan they would otherwise. The electrode extension device can be sometype of biased device, such as a coiled spring or some other type ofspring. The electrode extension device can also be a biased member madeof foam. The foam structure would be compressed under the electrode whenthe adhesive cover is applied. When the adhesive cover is removed, thecompressed foam would force the electrode to extend out from the bodysurface of the pad by two to five millimeters or more, preferably.

A foam pad or other biased device would also apply the correct pressurethat would be transmitted to the electrode and thus, to the patient'sskin. This will produce the highest quality contact and conductivity,which is directly related to the performance of the recording.

The body surface of the pad includes an adhesive layer made frombiocompatible and non-allergic materials. This will be attached to theskin upon removal of the cover. Another feature of the invention is thatthe electrodes may be pre-coated with a transmitting gel, which would besandwiched between the electrode and the cover of the adhesive layer.When the adhesive cover is removed, the transmitting gel would remain onthe electrode contact surface and be available to improve the connectionbetween the electrode and the patient's skin. All of these featuresresult in a precordial pad that can improve the repeatability of testresults, which can stabilize the pad during a particular test, which canread low temperatures and send that information to the EKG machine, andwhich facilitates rapid, accurate, and repeatable placement of theprecordial pad of the invention. This pre-application of gel alsoeliminates a possible route of cross contamination.

The precordial pad of the invention also includes a temperature sensorbuilt into the pad body. The temperature sensor measures a low range ofbody temperatures. It is when a patient's body temperature is in a lowrange that the electrical pattern of the heart will be affected. Knowingthis factor in the recording is key to distinguishing the pattern of anormal from an abnormal EKG, as an EKG taken from a patient who is at abelow normal temperature will have altered the readings. If that EKG isreviewed at a later time, a full interpretation of the EKG readingswould not be possible without knowledge of the patient's temperature atthe time the reading was taken. For that reason, a temperature sensor isbuilt into the pad body. The temperature sensor would also be linked tothe data-transmitting module, and sent to the EKG machine for recordingwith other data.

The micro-transmitter for the limb electrodes uses the same technologyfor the four electrodes of the limb leads. This can be associated witheach single electrode for wireless transmission, if applicable.

Added features of the precordial pad of the invention are connectionpoints to the four limb electrodes. These sensing sites are on the fourlimb of the patient, including the right arm, left arm, the right ankle,and the left ankle, or their adjusted positions on the chest of thepatient. The designed sets of limb electrodes of this invention are alsocapable of attachment on the chest, rather than on the limb, to simplifythe installation of electrodes for EKG test if the user chooses. The padbody of the invention would include sites to allow electrodes from thefour limb to connect to the pad body and be routed with the informationfrom the other electrodes of the pad body to the EKG machine.

Further, the purpose of the foregoing abstract is to enable the UnitedStates Patent and Trademark Office and the public generally, andespecially the scientists, engineers, and practitioners in the art whoare not familiar with patent or legal terms or phraseology, to determinequickly from a cursory inspection the nature and essence of thetechnical disclosure of the application. The abstract is neitherintended to define the invention of the application, which is measure bythe claims, nor is it intended to be limiting as to the scope of theinvention in any way.

Still other objects and advantages of the present invention will becomereadily apparent to those skilled in this art from the followingdetailed description, wherein I have shown and described only thepreferred embodiment of the invention, simply by way of illustration ofthe best mode contemplated by carrying out my invention. As will berealized, the invention is capable of modifications in various obviousrespects all without departing from the invention. Accordingly, thedrawings and description of the preferred embodiment are to be regardedas illustrative in nature, and not as restrictive in nature.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a view of the surface of the precordial pad, which would faceaway from the patient.

FIG. 2 is a view of the circuit layer of the precordial pad, withdetachable limb leads.

FIG. 3 is a view of the circuit layer of the precordial pad withdetachable limb leads in the attached position.

FIG. 4 is a view of the precordial pad with limb leads attached, showingthe surface which contacts the patient.

FIG. 5 is a view of the precordial pad that does not have limb leads,showing the side which contacts the patient.

FIG. 6 is a view of the attachable limb leads.

FIG. 7 is a view of a positioning device detached from the pad.

FIG. 8 is a view of the electrodes in closed and opened positions.

FIG. 9 shows various configurations of the universal adaptor.

FIG. 10 shows internal structure of the universal adaptor.

FIG. 11 is a view of the data transmitting module.

FIG. 12 shows the pad of the invention with optional attachment to anEKG machine and selected non-EKG devices.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

While the invention is susceptible of various modifications andalternative constructions, certain illustrated embodiments thereof havebeen shown in the drawings and will be described below in detail. Itshould be understood, however, that there is no intention to limit theinvention to the specific form disclosed, but, on the contrary, theinvention is to cover all modifications, alternative constructions, andequivalents falling within the spirit and scope of the invention asdefined in the claims.

While there is shown and described the present preferred embodiment ofthe invention, it is to be distinctly understood that this invention isnot limited thereto but may be variously embodied to practice within thescope of the following claims.

Several preferred embodiments of the invention are shown in FIGS. 1-12.FIG. 1 shows a disposal EKG precordial pad of the invention, which isdesignated as 10. This embodiment of the invention includes a pad body12, which includes a sliding site for module attachment 14 and atemperature window 16. The pad body includes an outer surface 18 and abody surface 20. FIG. 1 is a view of the outer surface, with the bodysurface 20 being located on the opposite side of this view of the padbody 12. In this view of the precordial pad body 10, the embeddedelectrodes are not visible. A data-transmitting module 22 interfaceswith the sliding site for module attachment 14. This will be discussedfurther in other figures. A temperature sensor 24 is also present in thedevice, with data from the temperature sensor 24 being displayed in thetemperature window 16. The precordial pad 10 includes a positioningextension 26. In the embodiment shown in FIG. 1, the position extension26 is attached to the pad body 12. Other embodiments of the device couldinclude a positioning extension 26 which is detachable or not attachedat all, to the pad body 12.

A doctor, technician or any professional or non-professional user usesthe positioning extension 26 on a patient to determine the correctplacement of the precoridal pad 10. The positioning extension 26includes a supra sternal notch 28. The supra sternal notch 28 is meantto be placed adjacent the manubrium, which is the bone adjacent to thejugular notch directly above the ribcage and at a patient's throat. Byplacing the supra sternal notch 28 of the precordial pad 10 adjacent thejugular notch of the patient, the electrodes of the precordial pad areassured of being placed in the proper anatomical position on a patient.Also included in the precordial pad 10, shown in FIG. 1, is an upperright limb lead 30. Although this is on the left hand side of FIG. 1, itwould be associated with the patient's right side. Also, in theembodiment in FIG. 1 is a lower right limb lead 32, an upper left limblead 34, and a lower left limb lead 36.

Shown in FIG. 2 is another favored embodiment of the invention. In thisembodiment, the limb leads are available as attachments to the pad body12. This embodiment includes a right limb lead assembly 38 and a leftlimb lead assembly 40. The embodiment shown in FIG. 2 shows the circuitlayer 42 of the pad body 12. In the circuit layer 42, the electricalconnections which are associated with each electrode are visible. Theelectrodes include an upper right limb lead connection 44 and a lowerright limb lead connection 46, to which the upper right limb lead 30 andthe lower right limb lead 32 are connected when the right limb leadassembly 38 is attached to the pad body 12. The electrical connectionswould be sufficient to carry higher voltages if to be used with adefibrillation option. In such a case, only certain predeterminedelectrodes would be used for defibrillation.

Similarly, an upper left limb lead connection 48 is provided, as well asa lower left limb lead connection 50. These are provided so that aconnection can be made with the upper left limb lead 34 and the lowerleft limb lead 36, which are part of the left limb lead assembly 40.These limb lead assemblies 38 and 40 can optionally be snapped intoplace, or the pad body may be used without limb leads. Electrode 52 isthe V1 electrode, electrode 54 is the V2 electrode, the electrode 56 isthe V3 electrode, electrode 58 is the V4 electrode, electrode 60 is theV5 electrode, and electrode 62 is the V6 electrode. The positions ofthese electrodes, V1 through V6, correspond to known electrodegeometries and provide an accurate EKG reading when positioned on thepatient's body correctly.

As in FIG. 1, the embodiment of FIG. 2 includes a positioning extension26. As can be seen in FIG. 2, electrical connection between each of theelectrodes is made with the module attachment site 14. Adata-transmitting module 22, not shown in FIG. 2, is utilized totransmit the data from each of the electrodes to the EKG machine.Electrode 64 is provided to obtain a temperature reading, which isconveyed to the site for module attachment 14 and to thedata-transmitting module 22.

FIG. 3 shows the right limb lead assembly 38 and the left limb leadassembly 40 attached in place on the pad body 12, showing the circuitlayer 42 and the temperature sensor 24.

The embodiment shown in FIG. 4 is the same as that in FIG. 3. However,what is shown is the body surface of the pad body, also called the bodysurface layer. This is the view of the device, as it would contact thepatient's body. The electrodes 52, 54, 56, 58, 60, 62, and 64 are shown.They are connected by the electrical connection shown in FIG. 3, whichis not visible in this view. The right and left limb lead assemblies 38and 40 are shown in their attached configuration, attached to theconnections 44, 46, 48, and 50. Shown around each electrode is a zone ofadhesive material. Adhesive material may also optionally be placed onthe pad body 12 in various locations.

FIG. 5 is a view of the second surface 20 of the pad body, the surfacewhich contacts the patient's skin. This version of the device does nothave the right or left limb lead assembly, and shows an optionalconfiguration of the precordial pad 10.

FIG. 6 shows view of the right limb lead assembly 38 and the left limblead assembly 40, which may be optionally used with the versions of theprecordial pad 10 which are shown in FIGS. 2-4. FIG. 7 shows thepositioning extension 26 which can be detachable from, or used as aseparate piece with the precordial pad 10.

FIG. 8 shows a cross-sectional and enlarged view of an electrode 72 inthe precordial pad. Also shown, are the first surface of the pad body 18and the second surface of the pad body 20. The second surface of the padbody 20 would be positioned against the skin of the patient. Between theelectrode 72 and the first surface 18, is a biased member 74. The biasedmember 74 is a device which is stored under some degree of compressionand, when released, expands and causes the electrodes 72 to move awayfrom the first surface 18. The biased member 74 can be a spring, such asa coil spring, or it can be a compressible substance such as foam. Whenreleased, either the spring or the foam would expand and cause theelectrode 72 to move away from the first surface 18. On the electrode72, the surface opposite the biased member 74 is a conductive gel 76.The conductive gel 76 is added to the surface of the electrode 72 duringmanufacture. On the second surface 20 a layer of adhesive 68 is located.A cover layer 78 covers the adhesive 68. When the cover layer 78 isremoved, as shown in the lower corner of FIG. 8, the biased member 74expands and pushes the electrode 72 away from the first surface 18.Removal of the cover layer 78 exposes the adhesive surface 68 and thegel 76.

FIG. 9 shows a number of configurations by which the EKG system of theinvention would transmit information to any EKG machine. Shown in FIG. 9is the universal adaptor/receiver of the accessory system. The universaladaptor/receiver is numbered 66. The universal adaptor can take severalconfigurations, which are shown in FIG. 9. In the upper left corner ofFIG. 9 is an example of the adaptor/receiver 66 of the inventionconfigured for wireless reception of information from electrodes fromthe precordial pad. It is also configured for hardwired input of datafrom the limb electrodes. Shown on the adaptor/receiver 66 is atemperature window 70, which is a separate window from the temperaturewindow 16, which is located on the precordial pad. From theadaptor/receiver 66, wires extend to the EKG machine. From the foregoingdescription, it will be apparent that various changes may be madewithout departing from the spirit and scope of the invention as definedby the following claims.

In the lower left corner of FIG. 9 is a depiction of a universaladaptor/receiver 66 of the invention, which is configured for hardwiretransmission of data from the precordial pad and from the limbelectrodes.

In the upper right corner of FIG. 9 is a depiction of theadaptor/receiver 66, which is configured to receive wirelesstransmission from both the electrodes of the precordial pad and limbelectrodes.

In the lower right corner of FIG. 9 is a universal adaptor/receiver 66configured to receive hardwired information from the electrodes of theprecordial pad and wireless data from the limb electrodes. Any of theseconfigurations of the universal adaptor/receiver 66 of the invention arepossible.

FIG. 10 is a view of some of the details of the universaladaptor/receiver 66. Shown, are inputs for the four limb electrodes aswell as inputs for the precordial cable. A wireless switch 80 is shownfor switching the unit from wireless to wired operation. Also shown, isan antenna 82 for receiving a wireless signal from the precordial pad ofthe invention. The antenna 82 is connected to a receiver 84 thatreceives, processes, and transmits the information from the precordialpad to outlet jacks 86. Outlet jacks 86 are available for connection tothe EKG machine. This would typically be by a wired connection, butusing wireless technology for this connection would also be possible.Thermometer window 70 is also shown.

FIG. 11 shows a system transmitting module, which has also been calledthe signal export device 22. It has a first surface 86 and a secondsurface 88. The second surface 88 includes contact points 90 whichprovide electrical connection with the electrodes or the precordial pad.The signal export device 22 connects to the precordial pad 10 by meansof the sliding site for module attachment 14. The signal export devicesinclude sliding borders 92, which allow it to slide into a positiveengagement with the sliding site for module attachment 14. Althoughbrackets on the side of the unit are shown, attachment could beaccomplished by a number of configurations, as are well known in theindustry. This unit could be operated with a cable 94 or could operateby wireless transmission.

FIG. 12 shows a pad of the invention and possible connections with whichit can be used. These include an EKG machine, a defibrillator, a realtime heart monitoring system, and an external heart pacing machine.

1. A disposable EKG precordial pad comprising: a pad body for conductiveattachment to a patient's torso, with a first and a second surface, witha plurality of electrodes which are embedded in said pad body but whichextend from said pad body before application for contact with a patient,and with an adhesive surface on said second surface for contact withsaid patient's skin; a temperature sensor; an adhesive cover, which isremovable for exposing said adhesive surface before use; at least oneelectrode extension device, for causing at least one of said pluralityof electrodes to extend beyond said adhesive surface when said adhesivecover is removed, wherein said electrode extension device is a biasedmember mounted between each of said plurality of electrodes and saidpad, said electrode extension device is held in biased position by saidadhesive cover, and said electrode extension device moves at least oneof said plurality of electrodes away from said pad when said adhesivecover is removed; and a positioning device for use with a patient fororienting and positioning said pad body for correct positioning on saidpatient.
 2. The disposable EKG precordial pad of claim 1 which furtherincludes a data transmitting module, for sending a plurality of signalsfrom said embedded electrodes to an EKG machine.
 3. The precordial padof claim 2 in which the data transmitting module is a wirelesstransmitter.
 4. The precordial pad of claim 2 in which thedata-transmitting module is a wire cable with individual wires.
 5. Thedisposable EKG precordial pad of claim 2 which further includes acircuit layer which is located between said first and said secondsurface, and which includes electronic connections between saidelectrodes and said data transmitting module.
 6. The disposable EKGprecordial pad of claim 5 in which said circuit layer is comprised of aninsulating sheet on which is placed electrical connections in the formof conductive pathways.
 7. The disposable EKG precordial pad of claim 6in which said conductive pathways are metallic ink circuitry.
 8. Theprecordial pad of claim 2 in which said electrodes each have amicro-transmitter for wireless transmission of a signal to said datatransmitting module.
 9. The precordial pad of claim 2 in which said datatransmitting module further includes a temperature display forindicating the patient's body temperature.
 10. The precordial pad ofclaim 2 in which the data-transmitting module is a wire harness forconnection to an EKG machine.
 11. The disposable EKG precordial pad ofclaim 1, in which said plurality of electrodes includes one or moremicro-transmitters for sending a signal from at least one of saidplurality of electrodes.
 12. The precordial pad of claim 1 in which saidelectrode extension device is a spring.
 13. The precordial pad of claim1 in which said electrode extension device member is a foam structure.14. The precordial pad of claim 1 in which said electrodes are packagedunder said adhesive cover with a layer of transmitting gel, so that whensaid adhesive cover is removed, said transmitting gel and said embeddedelectrodes are configured to be exposed.
 15. The precordial pad of claim1 in which said temperature sensor is a low reading temperature sensor.16. The precordial pad of claim 1 that further comprises six precordialelectrodes in a predetermined geometry.
 17. The precordial pad of claim16 which further includes connection points for attachment of limbelectrodes.
 18. The precordial pad of claim 17 which further includesconnection points for attachment of 4 limb electrodes at the user'sdiscretion.
 19. The precordial pad of claim 16 which further includestwo additional electrodes for right heart monitoring.
 20. The precordialpad of claim 1 that further comprises six torso electrodes and 4 limbelectrodes built into a single precordial pad.
 21. The precordial pad ofclaim 1 that further includes a low temperature window for displayingpatient temperature information.
 22. The precordial pad of claim 1 inwhich said pad further includes capability to connect to non-EKGdevices, including defibrillators, real time heart monitors, andexternal pacemakers.